Development and Validation of the Clinical Confidence and Psychodynamic Skills in Personality Disorder Questionnaire

Clinicians often experience frustration and uncertainty when working with patients with personality disorder (PD). Several evidence-based treatments are available, some deriving from psychodynamic theory. Despite the clinical relevance of confidence in managing such encounters, no validated measure of clinicians' confidence in assessing, structuring treatment, and applying psychodynamic skills in the work with PD patients exists. This study reports the development and validation of the Clinical Confidence and Psychodynamic skills in Personality Disorder Questionnaire (CCPPDQ). The CCPPDQ is a 13-item self-administered questionnaire. 314 psychiatrists and psychiatry residents from the United Kingdom, Italy, India, and Malaysia completed it during applied transference focused psychotherapy (TFP) training (2022-2024). Exploratory and confirmatory factor analyses identified and confirmed the underlying structure. Internal consistency, test-retest reliability, and convergent validity with the Attitudes to Personality Disorder Questionnaire (APDQ) were assessed. Gender differences and predictors of CCPPDQ scores were also analyzed. Analyses supported a two-factor structure: Confidence in Assessment and Structuring Treatment (CAST) and Confidence in Applying Psychodynamic Techniques (CAPT), accounting for 58.5% of total variance. The CCPPDQ showed excellent internal consistency (ω = 0.93) and strong test-retest reliability (ICC = 0.92). Convergent validity was supported by positive correlations with APDQ total and subscale scores, particularly Enjoyment and Security. Regression analyses identified age, gender, and APDQ scores as significant predictors of CCPPDQ outcomes. The CCPPDQ is a reliable tool for assessing clinicians' confidence in working with PD patients. Its subscales capture meaningful aspects of psychodynamic practice, offering utility for training, supervision, and research.